title: A practical scoring system to determine whether to proceed with surgical resection in recurrent glioblastoma.
abstract: BACKGROUND
  To determine the benefit of surgical management in recurrent glioblastoma, we analyzed a series of patients with recurrent glioblastoma who had undergone surgery, and we devised a new scale to predict their survival.
  
  
  METHODS
  Clinical data from 55 consecutive patients with recurrent glioblastoma were evaluated after surgical management. Kaplan-Meier survival analysis and Cox proportional hazards regression modeling were used to identify prognostic variables for the development of a predictive scale. After the multivariate analysis, performance status (P = .078) and ependymal involvement (P = .025) were selected for inclusion in the new prognostic scale. The devised scale was validated with a separate set of 96 patients from 3 different institutes.
  
  
  RESULTS
  A 3-tier scale (scoring range, 0-2 points) composed of additive scores for the Karnofsky performance status (KPS) (0 for KPS ≥ 70 and 1 for KPS < 70) and ependymal involvement (0 for no enhancement and 1 for enhancement of the ventricle wall in the magnetic resonance imaging) significantly distinguished groups with good (0 points; median survival, 18.0 months), intermediate (1 point; median survival, 10.0 months), and poor prognoses (2 points; median survival, 4.0 months). The new scale was successfully applied to the validation cohort of patients showing distinct prognosis among the groups (median survivals of 11.0, 9.0, and 4.0 months for the 0-, 1-, and 2-point groups, respectively).
  
  
  CONCLUSIONS
  We developed a practical scale to facilitate deciding whether to proceed with surgical management in patients with recurrent glioblastoma. This scale was useful for the diagnosis of prognostic groups and can be used to develop guidelines for patient treatment.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea. nsckpark@snu.ac.kr
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Sang-Bong
authors.initials: SB
authors.lastname: Chung
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Seol
authors.forename: Tae Min
authors.initials: TM
authors.lastname: Kim
authors.forename: Seung Hong
authors.initials: SH
authors.lastname: Choi
authors.forename: Se-Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Dae Seog
authors.initials: DS
authors.lastname: Heo
authors.forename: Il Han
authors.initials: IH
authors.lastname: Kim
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D049451:Nomograms; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
keywords: ependymal involvement; performance status; recurrent glioblastoma; scoring system; surgery